Momentum Program for Myrbetriq

The Momentum Savings Card for Myrbetriq is intended to help patients offset the cost of their prescription copay. Eligible patients may save up to $50 every month for a full year and for some patients it may cover the entire copay of their first prescription.* The patient is responsible for the first $20 plus any differential over $70 for each individual prescription. The program is available to those 18 years of age and older. Momentum savings offers are not for patients covered under Medicaid, a Medicare Part D or Medicare Advantage plan, Medigap, Veterans Administration, Department of Defense, TRICARE, CHAMPUS, Puerto Rico Government Health Insurance, or any other state or federal pharmaceutical benefit program or pharmaceutical assistance program and where prohibited by law.

* Eligibility and enrollment criteria apply.

Patients can obtain their Momentum Savings Card in the following ways:

Patients can call 1-855-326-1404 and have a card mailed to them in approximately 4-6 days

After enrolling, patients should take their prescription, along with their card (or the ID# if they haven't received their card in the mail yet), to a participating retail pharmacy.

Please note: If patients use a mail-order pharmacy, they should contact their pharmacy provider to ensure that this offer will be accepted. If the mail-order pharmacy will not process the voucher, they should call 1-855-326-1404 (Monday—Friday, 8 a.m-8 p.m., EST, excluding holidays) and request to speak to an agent. An agent will mail a Direct Member Reimbursement (DMR) form to them. The form should be completed and returned to the address on the form, along with their pharmacy receipt. If the patient is eligible, they will receive their benefit in the mail. They can also visit www.patientrebateonline.com to obtain a DMR form.

PLEASE SEE INDICATION AND IMPORTANT SAFETY INFORMATION HERE.
PLEASE SEE FULL PRESCRIBING INFORMATION HERE.